Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011

Word Reading and Attention-Deficit/Hyperactivity Disorder in Children With Developmental Language Disorder

PURPOSE

This study evaluated the relationship between word reading and symptoms of attention-deficit/hyperactivity disorder (ADHD) in school-age children with and without developmental language disorder (DLD), considering the influence of cognitive-linguistic mechanisms associated with dyslexia (phonological memory) and ADHD (working memory).

METHOD

Community ascertainment and blinded assessments identified 46 confirmed DLD and 76 cases of typical language development from a screening sample of 420 second and third graders. Language, word reading, ADHD symptoms, nonverbal intelligence, working memory, and phonological memory were assessed.

RESULTS

In all models, phonological memory was associated with word reading, and working memory was associated with ADHD symptoms. Additionally, in the new model of association that accounted for comorbidity with cognitive-linguistic indices, named the "Reading, ADHD, and Language (RE.A.L.) Comorbidity Model," word reading was uniquely mediated by phonological memory.

CONCLUSIONS

Findings highlight the unique role cognitive-linguistic indices associated with dyslexia and ADHD play in explaining the relationship between DLD, word reading, and ADHD symptoms. Results indicate that ADHD symptoms did not predict poor word reading; only phonological memory mediated the relationship between DLD and word reading difficulties associated with dyslexia. Similarly, working memory was associated with ADHD symptoms only. Findings underline the importance of including cognitive-linguistic indices associated with dyslexia and ADHD in evaluating word reading and ADHD symptoms in children with DLD.

Genetic and phenotypic evidence of the predictive validity of preschool parent reports of hyperactivity/impulsivity and inattention

To determine the validity of parent reports (PRs) of ADHD in preschoolers, we assessed hyperactivity/impulsivity (HI) and inattention (IN) in 1114 twins with PRs at 1.5, 2.5, 4, 5, 14, 15, and 17 years, and teacher-reports at 6, 7, 9, 10, and 12. We examined if preschool PRs (1) predict high HI/IN trajectories, and (2) capture genetic contributions to HI/IN into adolescence. Group-based trajectory analyses identified three 6-17 years trajectories for both HI and IN, including small groups with high HI (N = 88, 10.4%, 77% boys) and IN (N = 158, 17.3%, 75% boys). Controlling for sex, each unit of HI PRs starting at 1.5 years and at 4 years for IN, increased more than 2-fold the risk of belonging to the high trajectory, with incremental contributions (Odds Ratios = 2.5-4.5) at subsequent ages. Quantitative genetic analyses showed that genetic contributions underlying preschool PRs accounted for up to a quarter and a third of the heritability of later HI and IN, respectively. Genes underlying 1.5-year HI and 4-year IN contributed to 6 of 8 later HI and IN time-points and largely explained the corresponding phenotypic correlations. Results provide phenotypic and genetic evidence that preschool parent reports of HI and IN are valid means to predict developmental risk of ADHD.

Dual-Responsive Ion-Exchange Resin Encapsulated Atomoxetine Hydrochloride for Taste-Masking and Biphasic Release

Atomoxetine hydrochloride (ATH) is a first-line medication used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children. However, it poses challenges such as a bitter taste and difficulties in dose adjustment. While once-daily administration may result in excessive drug exposure, twice-daily dosing improves plasma drug concentration stability but can reduce patient compliance, especially in school-aged children. To address these challenges, a novel strategy was proposed that involves encapsulating ATH into ion exchange resins (IERs) (referred to as ATH@IER). The pH-responsive release of ATH from the ATH@IER exhibited a limited release rate in neutral conditions, effectively masking the bitter taste, which was evaluated through electronic tongue analysis. The cation-responsive release of ATH from the ATH@IER demonstrated immediate-release (IR) property, which was combined with Eudragit® RS100 coated ATH@IER (ATH@MC) to establish a biphasic release system. ATH orally disintegrating tablets (ATH ODT) were manufactured using a composition of ATH@IER and ATH@MC (40:60, w/w), along with other excipients. Pharmacokinetic studies demonstrated that a single dose of ATH ODT produced a bimodal plasma concentration, resulting in a two-fold decrease in peak concentration (Cmax) while maintaining an unchanged area under the drug concentration-time curve (AUC0-t) compared to the commercial ATH oral solution administered once. Notably, the plasma drug concentration of ATH ODT remained steadier than that of the commercial product when administered twice. In conclusion, ATH ODT represents a promising formulation that effectively masks bitter taste and provides biphasic release for the treatment of ADHD.

The Importance of Physical Activity Variability and Its Relation with Attention-Deficit/Hyperactivity Disorder Symptoms in Young Children

OBJECTIVES

There is a need to examine the utility of objective measures of attention-deficit/hyperactivity disorder (ADHD) symptoms in children. Objective measures of ADHD symptoms, such as physical activity, may provide a more nuanced assessment of behavior that can be used to augment traditional cross-informant ratings of ADHD symptoms by parents and teachers. The most widely used and researched technique for objectively capturing children's physical activity is accelerometry (i.e., the use of small devices that measure gravitational acceleration). The current study examined the unique and interactive effects of mean levels of physical activity (physical activity volume) and intra-individual variability in physical activity (physical activity variability), as measured by accelerometry, on teacher-reported ADHD symptoms (hyperactivity/impulsivity and inattention examined separately).

METHOD

One hundred seventy-six early elementary school students (Mage = 6.83, SD = 0.96, 53% male) from four midwestern schools and four northeastern schools were included. All were participants in a before-school intervention study involving physical activity or a sedentary classroom program. Data were collected using accelerometry during the intervention period and ADHD symptoms were reported by teachers following the intervention. Multiple regression models were used to examine the unique and interactive effects of physical activity volume and physical activity variability on ADHD symptoms.

RESULTS

Results demonstrated that physical activity volume was positively associated with hyperactive/impulsive symptoms, whereas physical activity variability was negatively associated with hyperactive/impulsive and inattentive symptoms. Additionally, when both physical activity variables were in the same model, only physical activity variability uniquely predicted ADHD symptoms after accounting for physical activity volume. Specifically, higher physical activity variability was linked with lower hyperactive/impulsive and inattentive symptoms.

CONCLUSION

Objective measures of physical activity volume and physical activity variability may enhance our understanding of physical activity patterns as they relate to ADHD symptoms. Future research should continue to investigate the usability of objective measures of physical activity, and especially physical activity variability, as a screener to identify children at risk for ADHD.

Development of a Mobile-Based Personal Health Record for Pediatric Attention-Deficit/Hyperactivity Disorder Management: Protocol for a Study Based on Action Research Design

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most widespread neurobehavioral problems during childhood. A child's personal health record (PHR) plays an important role in the controlled routine monitoring of ADHD symptom improvement. Along with the advantages, the convenience offered by mobile technology, and the ubiquity of smartphones in contemporary society, there is a compelling need for PHR to be available in the form of a mobile app.

OBJECTIVE

This study aims to identify stakeholder needs, followed by designing, developing, testing, and evaluating a mobile-based PHR in the context of pediatric ADHD management.

METHODS

This study will adopt an action research design structured into 4 stages: diagnosing, planning, taking, and evaluating action. Stakeholders, including parents, pediatricians, occupational therapists, clinical psychologists, and teachers, will participate actively. In stage 1, stakeholder requirements for the mobile-based PHR will be explored through in-depth interviews, focus group discussions (FGDs), and document reviews. Thematic analysis will be used to identify key needs and challenges. In stage 2, a systematic literature review will be conducted to enhance user requirements analysis by synthesizing insights from existing mobile apps for pediatric ADHD management. A mobile-based PHR prototype will be designed and developed based on user requirements enhanced with systematic review results. In stage 3, the prototype will undergo a 6-week trial with participants to evaluate its functionality and address any identified issues. In stage 4, both quantitative and qualitative methods will be used to assess the app's usability and quality. The System Usability Scale (SUS) and the User Version of the Mobile App Rating Scale (uMARS) will be used for quantitative evaluation, while interviews and FGDs will be conducted for qualitative evaluation.

RESULTS

This study commenced in October 2024. As of December 2024, 13 participants (n=5, 38.5%, parents; n=2, 15.4%, pediatricians; n=2, 15.4%, occupational therapists; n=2, 15.4%, clinical psychologists; and n=2, 15.4%, teachers) have been enrolled, meeting the minimum participant requirements for stage 1. Stage 1 was completed at the end of 2024, with stage 2 expected to be completed by September 2025, stage 3 by December 2025, and stage 4 by February 2026. The findings from each stage will inform iterative refinements to the mobile-based PHR. The final results, including usability and quality assessments, are anticipated for publication by the middle of 2026.

CONCLUSIONS

This study protocol outlines a pivotal initiative to enhance the management of pediatric ADHD. By using an action research methodology and actively engaging stakeholders, the study aims to contribute significantly to the field. The iterative cycles of the research seek to develop a mobile-based PHR that is not only user friendly but also effective and uniquely attuned to the diverse needs of those involved in pediatric ADHD care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/60216.

Systematic Review and Meta-Analysis: Attention-Deficit/Hyperactivity Disorder Symptoms in Children With Neurofibromatosis Type 1

OBJECTIVE

This meta-analysis aimed to robustly estimate differences in attention-deficit/hyperactivity disorder (ADHD) symptoms between children and adolescents with and without neurofibromatosis type 1 (NF1).

METHOD

Systematic literature searches were conducted in Scopus, PsycINFO, Web of Science, PubMed, and ProQuest in September 2022, with a supplemental search conducted in Google Scholar in February 2023. The searches identified 2,153 unique articles. Screening identified 114 academic journal articles that assessed parent/caregiver- or teacher-reported ADHD symptoms for children/adolescents with NF1. Two researchers independently screened articles and extracted data. The primary outcome was group differences in ADHD symptoms between children/adolescents with and without NF1 (Hedges g). Data were analyzed using robust variance estimation and random-effects models.

RESULTS

The meta-analysis included 70 studies (138 effect sizes), involving 3,653 children/adolescents with NF1 (46% female; mean age = 9.69 years, SD = 2.60 years) and 4,895 children/adolescents without NF1 (48% female; mean age = 10.03 years, SD = 3.10 years). According to parent/caregiver reports, children/adolescents with NF1 exhibited more severe inattentive symptoms (g = 1.20; 95% CI = 1.06-1.35), hyperactive/impulsive symptoms (g = 0.85; 95% CI = 0. 68-1.03), and combined ADHD symptoms (g = 1.02; 95% CI = 0.87-1.17) than unaffected controls. Inattentive ADHD symptoms were more elevated than hyperactivity/impulsivity for children/adolescents with NF1. Larger effect sizes for inattention and hyperactivity/impulsivity were associated with older age, lower intelligence quotient (IQ), and parent/caregiver vs teacher reports.

CONCLUSION

NF1 is a monogenic condition that has strong associations with elevated ADHD symptoms. Findings highlight the importance of early intervention and targeted support for ADHD-related problems in children with NF1.

PLAIN LANGUAGE SUMMARY

Increasing evidence has suggested a higher risk for attention-deficit/hyperactivity disorder (ADHD) in individuals with neurofibromatosis type 1 (NF1). In this study of ADHD symptom severity in youth with NF1, the authors analyzed data from 70 articles. The authors found much more severe ADHD symptoms in children and adolescents with NF1 compared to youth without NF1. Inattentive symptoms were more pronounced in children with NIF who were older or had a lower IQ.

STUDY PREREGISTRATION INFORMATION

Compare the ADHD problems between NF1 and control groups; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=462063.

Evaluating the effectiveness of the complementary therapy web application based on Kiddo game therapy on children with attention deficit hyperactivity disorder: a before and after study

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurological disorders, especially in childhood. Children with ADHD may have symptoms such as an inability to maintain concentration and attention, inappropriate developmental performance, and impulsivity. Play therapy helps to improve such symptoms by making the treatment process attractive. Therefore, the purpose of this study was to investigate the effectiveness of the Kiddo game-based complementary therapy web application in this disorder. This study was conducted in 2022 on 40 children aged 4 to 12 years in 2 psychotherapy clinics located in two cities. The available sampling method was used to select participants. At first, the Conners questionnaire was completed by the children's parents, and then the Kiddo web application was made available for two months. At the end, the Conners questionnaire was again completed by the parents. Nearly 31 children with ADHD were evaluated. The average age was 6.48 ± 1.89. The highest percentage of children was in preschool. A significant difference was observed between the average Conners scores before and after the intervention (P < 0.001). The results showed that complementary treatment based on play therapy improves the quality of life in ADHD children and reduce the amount and severity of the disorder. Intervention based on remote play therapy can be used as an effective, accessible, and low-cost intervention for children with ADHD.

Retinal fundus imaging as biomarker for ADHD using machine learning for screening and visual attention stratification

Attention-deficit/hyperactivity disorder (ADHD), characterized by diagnostic complexity and symptom heterogeneity, is a prevalent neurodevelopmental disorder. Here, we explored the machine learning (ML) analysis of retinal fundus photographs as a noninvasive biomarker for ADHD screening and stratification of executive function (EF) deficits. From April to October 2022, 323 children and adolescents with ADHD were recruited from two tertiary South Korean hospitals, and the age- and sex-matched individuals with typical development were retrospectively collected. We used the AutoMorph pipeline to extract retinal features and used four types of ML models for ADHD screening and EF subdomain prediction, and we adopted the Shapely additive explanation method. ADHD screening models achieved 95.5%-96.9% AUROC. For EF function stratification, the visual and auditory subdomains showed strong (AUROC > 85%) and poor performances, respectively. Our analysis of retinal fundus photographs demonstrated potential as a noninvasive biomarker for ADHD screening and EF deficit stratification in the visual attention domain.

Linking Electronic Health Record Prescribing Data and Pharmacy Dispensing Records to Identify Patient-Level Factors Associated With Psychotropic Medication Receipt: Retrospective Study

Background

Pharmacoepidemiology studies using electronic health record (EHR) data typically rely on medication prescriptions to determine which patients have received a medication. However, such data do not affirmatively indicate whether these prescriptions have been filled. External dispensing databases can bridge this information gap; however, few established methods exist for linking EHR data and pharmacy dispensing records.

Objective

We described a process for linking EHR prescribing data with pharmacy dispensing records from Surescripts. As a use case, we considered the prescriptions and resulting fills for psychotropic medications among pediatric patients. We evaluated how dispensing information affects identifying patients receiving prescribed medications and assessing the association between filling prescriptions and subsequent health behaviors.

Methods

This retrospective study identified all new psychotropic prescriptions to patients younger than 18 years of age at Duke University Health System in 2021. We linked dispensing to prescribing data using proximate dates and matching codes between RxNorm concept unique identifiers and National Drug Codes. We described demographic, clinical, and service use characteristics to assess differences between patients who did versus did not fill prescriptions. We fit a least absolute shrinkage and selection operator (LASSO) regression model to evaluate the predictability of a fill. We then fit time-to-event models to assess the association between whether a patient filled a prescription and a future provider visit.

Results

We identified 1254 pediatric patients with a new psychotropic prescription. In total, 976 (77.8%) patients filled their prescriptions within 30 days of their prescribing encounters. Thus, we set 30 days as a cut point for defining a valid prescription fill. Patients who filled prescriptions differed from those who did not in several key factors. Those who did not fill had slightly higher BMIs, lived in more disadvantaged neighborhoods, were more likely to have public insurance or self-pay, and included a higher proportion of male patients. Patients with prior well-child visits or prescriptions from primary care providers were more likely to fill. Additionally, patients with anxiety diagnoses and those prescribed selective serotonin reuptake inhibitors were more likely to fill prescriptions. The LASSO model achieved an area under the receiver operator characteristic curve of 0.816. The time to the follow-up visit with the same provider was censored at 90 days after the initial encounter. Patients who filled prescriptions showed higher levels of follow-up visits. The marginal hazard ratio of a follow-up visit with the same provider was 1.673 (95% CI 1.463-1.913) for patients who filled their prescriptions. Using the LASSO model as a propensity-based weight, we calculated the weighted hazard ratio as 1.447 (95% CI 1.257-1.665).

Conclusions

Systematic differences existed between patients who did versus did not fill prescriptions. Incorporating external dispensing databases into EHR-based studies informs medication receipt and associated health outcomes.

Prevalence of Obstructive Sleep Apnea in Vietnamese Children with Attention Deficit Hyperactivity Disorder (ADHD)

INTRODUCTION

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder among children with attention deficit hyperactivity disorder (ADHD). This study aims to determine the prevalence of OSA in children with ADHD, compare the differences in clinical characteristics between children with ADHD-OSA and those without OSA (ADHD-nonOSA), and to identify the correlation between OSA and ADHD in children.

METHODS

This cross-sectional descriptive study was conducted on 524 children with ADHD, aged 6-12 years, at the Vietnam National Children's Hospital from October 2022 to September 2023. Respiratory polygraphy was used to determine the prevalence of OSA in this study population; clinical data of children with ADHD-OSA and ADHD-nonOSA were collected and analyzed in each group. The severity of ADHD symptoms was measured by the Vanderbilt ADHD Parent Diagnosis Rating Scale (VADPRS questionnaire), and the severity of OSA was defined by Apnea-Hypopnea Index (AHI).

RESULTS

The prevalence of OSA in children with ADHD was 23.3%, with the majority of moderate-to-severe OSA. Significant differences were observed in sleep onset time, total sleep duration, and various sleep-related behaviors, such as bedtime resistance and difficulty waking up in the morning, between children with ADHD-OSA and ADHD-nonOSA (p < 0.001, p < 0.001, p < 0.05, and p < 0.005, respectively). The severity levels of inattention, hyperactivity, and behavioral disorders were significantly higher in children with moderate-to-severe OSA compared to those with mild OSA (p < 0.005, p < 0.005, and p < 0.001, respectively). There were significant correlations between AHI with inattention scores (r = 0.677; p < 0.0001), hyperactivity scores (r = 0.438; p = 0.05), behavioral disorder scores (r = 0.342; p < 0.05), and anxiety/depression scores (r = 0.357; p < 0.05) measured by VADPRS questionnaire.

CONCLUSIONS

OSA is a common sleep-related breathing disorder in children with ADHD, which might exacerbate ADHD symptoms. Thus, screening of OSA in children with ADHD is essential during the management of ADHD in this population.

Impact of fidget devices on anxiety and physiological responses in adults with ADHD

BACKGROUND

Fidgeting devices are popular for managing ADHD, but their effectiveness remains unclear. This study investigated whether fidgeting modulates self-regulation in adults with ADHD during stress, exploring intrinsic versus extrinsic fidgeting with a fidget ball. We hypothesized that individuals with a fidget ball would demonstrate improved self-regulation under stress, reflected by higher heart rate variability (HRV) and lower anxiety levels.

METHODS

Adults with ADHD were randomly assigned to a fidget ball (n = 49) or no fidget ball (n = 24) group. Physiological stress was measured via HRV and intrinsic fidgeting, that is, ankle and wrist movements, were measured via actigraphy. Physiological data were collected at baseline and during the Trier Social Stress Test (TSST). Self-rated anxiety was measured using the State Anxiety Inventory.

RESULTS

Heart rate and fidgeting increased across TSST stages for both groups, with no significant differences in heart rate, HRV, or intrinsic fidgeting between groups. Notably, the fidget ball group had weaker correlations between fidgeting and HRV compared to the no fidget ball group. At baseline, the no fidget ball group showed a positive correlation between intrinsic fidgeting and HRV, suggesting an association between intrinsic fidgeting and self-regulation, however during stress the no fidget ball group showed a significant negative correlation between intrinsic fidgeting and HRV. The relationship between physiological measures and anxiety differed between groups and TSST stages.

CONCLUSIONS

These results provide preliminary evidence that the fidget ball may disrupt the expected association between intrinsic fidgeting and HRV, emphasizing the need for further studies to explore its impact on self-regulation.

A Case Report: Lisdexamfetamine-Induced Delusional Parasitosis

Attention-deficit hyperactivity disorder (ADHD) is generally treated with stimulant medications without significant complications. Delusional parasitosis (Ekbom syndrome) can occur secondary to ADHD treatment. It is a rare condition defined as having a fixed, false belief that one is infected with insects, parasites, or organisms and that one experiences cutaneous sensations without any clinical evidence of infestation. Although stimulant treatment with methylphenidate or mixed amphetamine salts has been associated with delusional parasitosis, there is yet a case in the literature illustrating delusional infestation secondary to lisdexamfetamine. The following case is unique in that lisdexamfetamine caused delusional parasitosis in a 53-year-old man with ADHD who previously tolerated mixed amphetamine salts and armodafinil without side effects. The discontinuation of lisdexamfetamine, coupled with a second-generation antipsychotic, quickly resolved the delusion. For those who may prescribe lisdexamfetamine or treat patients with ADHD, it is crucial to carefully assess medication use, as discontinuation or dose adjustment of the suspected causative drug can have a positive impact on the course of delusional parasitosis.

Adult Diagnosis of ADHD in Women: A Mixed Methods Investigation

OBJECTIVE

The goal of this study was to examine the experiences of women diagnosed with ADHD in adulthood.

METHODS

Benefits and costs associated with obtaining the diagnosis were examined in two focus groups conducted virtually. Factors hindering and facilitating the identification, assessment, and subsequent treatment of ADHD were also explored. Focus groups were conducted virtually and together included 14 women (Mage = 39.43, SD = 6.37) who were diagnosed with ADHD in adulthood.

RESULTS

The majority of women described numerous benefits of receiving a diagnosis of ADHD, including validation/self-compassion, adaptive coping, and social support. Negative aspects of the diagnosis, including difficulties accessing care, the burden of care, limitations to existing evidence-based treatments, and stigma were also identified by some women. Furthermore, women described variable diagnostic experiences, with many indicating that they had not recognized their own symptoms of ADHD, as well as diagnostic complexity and other factors that masked identification of ADHD. Women described a range of diagnostic assessment procedures, as well as considerable self-advocacy to convince their providers to consider the diagnosis of ADHD.

CONCLUSION

These lived experiences of women diagnosed with ADHD provide critical insight into improving clinical care for ADHD in women. Recommendations to increase accurate and timely identification of ADHD in women and advance efforts toward effective and equitable care are discussed.

Linking Adherence to Effectiveness in Family-Based Adolescent ADHD Academic Training and Medication Decision-Making Protocols

OBJECTIVE

Changing Academic Support in the Home for Adolescents with ADHD (CASH-AA) and Medication Integration Protocol (MIP) are two family-based behavioral protocols designed to promote family solutions to academic problems and medication decision-making. Building on a randomized control trial examining these protocols, the current study examined how protocol dose, an indicator of treatment adherence, was associated with treatment outcomes.

METHOD

The sample consisted of 145 adolescent clients (M age = 14.8, 72% male, 42% White, 37% Hispanic, 15% Black) and 49 community and hospital-based therapists (82% female, 63% White, 29% Hispanic). Latent growth curve models examined how therapist reports of minutes adolescents and their caregivers received CASH-AA and MIP predicted levels and change in inattentive and hyperactive symptoms (MINI-International Neuropsychiatric Interview); co-occurring symptoms (Youth Self Report/Child Behavior Checklist); homework problems (Homework Problems Checklist); and medication compliance at baseline, 3, 6, and 12-month follow-ups.

RESULTS

MIP minutes were prospectively associated with lower caregiver-reported inattentive and hyperactive symptoms, adolescent- and caregiver-reported externalizing symptoms and caregiver-reported homework problems at the 12-month follow-up (ẞ range = -.16 to -.39, p < .05), as well as faster decline in caregiver-reported inattentive symptoms (ẞ = -.29, p < .001). CASH-AA minutes were associated with greater caregiver-reported inattentive symptoms (ẞ = .11, p = .049) at 12-month follow-up and slower declines in homework problems (ẞ = -.39, p < .001). Neither MIP nor CASH-AA minutes were associated with internalizing symptoms or medication use.

CONCLUSIONS

Findings further support MIP as an effective behavioral protocol for adolescent ADHD and indicate the need for increasing MIP implementation efforts in community settings.

Exploring the Intersection of ADHD and Music: A Systematic Review

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent neurodevelopmental disorder, affecting both children and adults, which often leads to significant difficulties with attention, impulsivity, and working memory. These challenges can impact various cognitive and perceptual domains, including music perception and performance. Despite these difficulties, individuals with ADHD frequently engage with music, and previous research has shown that music listening can serve as a means of increasing stimulation and self-regulation. Moreover, music therapy has been explored as a potential treatment option for individuals with ADHD. As there is a lack of integrative reviews on the interaction between ADHD and music, the present review aimed to fill the gap in research. Following PRISMA guidelines, a comprehensive literature search was conducted across PsychInfo (Ovid), PubMed, and Web of Science. A narrative synthesis was conducted on 20 eligible studies published between 1981 and 2023, involving 1170 participants, of whom 830 had ADHD or ADD. The review identified three main areas of research: (1) music performance and processing in individuals with ADHD, (2) the use of music listening as a source of stimulation for those with ADHD, and (3) music-based interventions aimed at mitigating ADHD symptoms. The analysis revealed that individuals with ADHD often experience unique challenges in musical tasks, particularly those related to timing, rhythm, and complex auditory stimuli perception, though these deficits did not extend to rhythmic improvisation and musical expression. Most studies indicated that music listening positively affects various domains for individuals with ADHD. Furthermore, most studies of music therapy found that it can generate significant benefits for individuals with ADHD. The strength of these findings, however, was limited by inconsistencies among the studies, such as variations in ADHD diagnosis, comorbidities, medication use, and gender. Despite these limitations, this review provides a valuable foundation for future research on the interaction between ADHD and music.

Black Mothers of Children With and Without ADHD: Relationships Among Maternal Psychopathology, Parenting Stress, and Parenting Cognitions

INTRODUCTION

Parents of children with attention-deficit/hyperactivity disorder (ADHD) endorse increased parenting stress and lower levels of parenting efficacy and satisfaction as compared to parents of children without ADHD. Additionally, maternal ADHD and depression differentiate children with and without ADHD, with children with ADHD being more likely to have a mother with psychopathology.

METHOD

With a focus on an understudied population, we investigated the extent to which maternal self-reported ADHD and depression were associated with self-reported parenting stress and parenting cognitions in 70 Black mothers of children with (maternal Mage = 35.52, SD = 6.49) and without ADHD (maternal Mage = 35.39, SD = 6.53) recruited from a metropolitan area in the southeastern United States.

RESULTS

Analyses indicated that Black mothers of children with ADHD reported higher levels of parenting stress, lower levels of parenting efficacy, and lower levels of parenting satisfaction. However, there were no significant differences between groups on measures of maternal ADHD or depression. Maternal depression significantly accounted for variability in both parenting satisfaction and parenting stress beyond child ADHD and maternal education. With maternal depression in the models, the association between maternal ADHD and parenting stress and parenting satisfaction lost significance.

DISCUSSION

Given the racial disparities in the treatment of ADHD, future research should focus on investigating the linkages between maternal depression, parenting stress, parenting satisfaction, and parenting behaviors in Black mothers in order to delineate whether there are cultural adaptations that may improve treatment utilization rates for child ADHD within this population.

Assessing the Causal Relationship Between Various Immune Cells and Attention Deficit Hyperactivity Disorder: Mendelian Randomization Study

BACKGROUND

Immune system modulation has been shown to have a significant impact on attention deficit hyperactivity disorder (ADHD). Mendelian randomization (MR) analysis was used in this study to investigate the potential role of different immune cells in the development of ADHD to provide therapy and preventative alternatives.

METHODS

In this study, 731 immune cells and the risk of ADHD were examined using publicly accessible genetic data and a two-sample MR analysis. Included were four different types of immunological profiles: determinate cells (DC), proportional cells (PC), median brightness level (MBL), and morphological characteristics (MA). It was discovered that single-nucleotide polymorphisms (SNPs) are linked to ADHD. To evaluate the dependability of the results, we conducted sensitivity analysis (heterogeneity and pleiotropy) and employed supplementary MR techniques, such as the inverse variance weighted (IVW) and MR-Egger. Graphs are used to display the final findings of the pertinent analyses.

RESULTS

Following MR analysis, immune cells associated with a few low p value phenotypes may influence ADHD, and these immune cells may serve as an inspiration for clinical treatment practices that aim to prevent and cure ADHD. Immune cell phenotypes that may both increase and worsen the likelihood of having ADHD were identified by IVW results. These included CD27 on memory B cells (OR = 1.066, 95% CI = 1.024-1.109, p = 2E-3) and CD27 on IgD-CD38- (OR = 1.059, 95% CI = 1.018-1.103, p = 5E-3), among others. Immune cell phenotypes that may act as a safeguard against ADHD included CD3 on resting Treg (OR = 0.925, 95% CI = 0.888-0.963, p = 1.5E-4) and SSC-A on monocytes (OR = 0.951, 95% CI = 0.924-0.980, p = 8.5E-4), among others. The primary findings and the outcomes of the sensitivity analysis matched.

CONCLUSIONS

This study provides a broad theoretical foundation for the development of immune-oriented therapeutic strategies in future clinical practice by demonstrating a potential genetic relationship between immune cells and ADHD. This study also advances our understanding of how to use the immune pathway to prevent and treat ADHD.

Current Perspectives on Attention-deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a neurobiological and neurodevelopmental disorder with an idiosyncratic genetic base. ADHD presents various characteristics, such as inattention, hyperactivity, and impulsivity. Over the period, ADHD leads to noticeable functional disability. A five- to ten-fold progressed risk of disorder development is observed in the populations with familial history of ADHD. The abnormal structure of the brain in ADHD results in altered neural mechanisms, such as cognition, attention, and memorial function. The mesolimbic, nigrostriatal, and mesocortical pathways in the brain get affected by the deterioration of the levels of dopamine. The hypothesis of dopamine in ADHD and its etiopathology suggests that detained attention and impaired arousal functions are due to reduced levels of dopamine. The quickest way to improve strategical treatment is by clarifying the etiological aspects of ADHD and identifying the underlying mechanisms of pathophysiology, which will assist in exploring the biomarkers for better diagnosis. The implementation of life course theory is a very important research principle announced by Grand Challenges in Global Health Initiative (GCMHI). Long-term research is needed to define the progression of ADHD. Interdisciplinary collaborations promise a great future for research innovations in ADHD.

Predictors of preschool attention-deficit/hyperactivity disorder diagnosis: a population-based study using national registers

BACKGROUND

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in preschool years (before age 6 years) is a marker of severity and poor prognosis. This study investigated a broad range of predictors of ADHD diagnosis during preschool age.

METHODS

Population-based cohort study using Swedish registers. The final sample consisted of all children born in Sweden between 2001 and 2007 who could be linked to both of their biological parents, excluding those who died or emigrated (n = 631,695). Follow-up was completed December 31, 2013. Cox proportional-hazards models for survival analysis were used to identify the predictors that increased the risk of receiving a clinical diagnosis of ADHD from 3 to 5 years. Hazard ratios (HR) with 95% confidence intervals (CI) were presented for each of the 41 selected predictors covering early-onset psychiatric comorbidities, nonpsychiatric medical conditions, parental history and perinatal factors.

RESULTS

At the end of follow-up, 1,686 preschoolers (2.7% of the whole sample) had received a diagnosis of ADHD. We found that 39 out of 41 predictors were associated with increased risk of a later diagnosis of preschool ADHD. Novel associations with preschool ADHD diagnosis were found for gastroesophageal reflux disease (HR = 3.48), premature contractions during pregnancy (HR = 2.03), and criminal conviction history from any parent (HR = 2.14).

CONCLUSIONS

A large number of novel and well-established predictors of preschool ADHD diagnosis were identified. This broad set of early predictors may direct future clinical research and assist in early identification of preschool ADHD.

Childhood mental health and educational attainment: Within-family associations in a late 20th Century U.S. birth cohort

Mental health problems during childhood are associated with lowered educational attainment in adulthood. However, it is not clear if these associations hold when controlling for unobserved features of the family environment and if they depend on the socioeconomic status (SES) of parents. We use the Panel Study of Income Dynamics (PSID) Child Development and Transition into Adulthood Supplements (CDS; TAS) to examine these questions. Using linear and logistic regression, we isolate within-family variability in mental health problems among full sibling pairs (n = 958 individuals in 479 pairs). Associations depend on the measure used. Parental reports of problem behaviors and diagnosed problems have the most consistent negative associations with educational attainment (for example, a hyperactivity diagnosis is associated with 0.74 fewer years of schooling). Retrospective self-reports of diagnoses other than depression or anxiety also have a negative association (0.96 fewer years of schooling). But self-reports of depressive symptoms and emotional or psychological well-being during late childhood and adolescence have no significant associations with educational attainment. In addition, there is no significant moderation of these associations by SES.

Toddler Screen Time: Longitudinal Associations with Autism and ADHD Symptoms and Developmental Outcomes

Greater screen time is associated with increased symptoms of autism spectrum disorder (autism), attention-deficit/hyperactivity disorder (ADHD), and lower scores on measures of development in preschool-aged community samples. In the current longitudinal study, we examined screen time differences at 18 months of age based on clinically-defined outcomes (i.e., Autism, ADHD Concerns, Comparison) determined at age 3-5 years in a genetically-enriched sample based on family history, along with prospective associations between toddler screen time and preschool autism/ADHD symptoms and developmental achievement. Participants (n = 82) included children at high and low familial likelihood for autism and ADHD. Children with Autism and ADHD Concerns outcomes experienced significantly more screen exposure at 18 months than children without autism or elevated symptoms of ADHD. Greater screen time at 18 months was also associated with preschool symptoms of autism and ADHD and lower developmental achievement across the sample. Preschoolers with neurodevelopmental challenges experienced more screen exposure earlier in development than same-age peers, increasing potential for negative developmental impacts.

Impulsivity in ADHD and Borderline Personality Disorder: A Systematic Review of Gray and White Matter Variations

Introduction: Impulsivity is one of the overlapping symptoms common to borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD), but the neurobiological basis of these disorders remains uncertain. This systematic review aims to identify abnormalities in the gray and white matter associated with impulsivity in BPD and ADHD. Methods: We conducted a systematic search of the PubMed, Embase, and SCOPUS databases, adhering to PRISMA guidelines. Studies that investigated gray and white matter alterations in BPD or ADHD populations and their relationship with impulsivity were included. We reviewed information from 23 studies involving 992 participants, which included findings from structural MRI and DTI. Results: The review identified various nonhomogeneous changes associated with impulsivity in BPD and ADHD. BPD was mainly associated with abnormalities in the prefrontal cortex (PFC) and limbic areas, which correlated negatively with impulsivity. In contrast, impulsivity associated with ADHD was associated with structural changes in the caudate nucleus and frontal-striatal pathways. Despite the overlapping symptoms of impulsivity, the neurobiological mechanisms appeared to differ between the two disorders. Conclusions: These findings emphasize the distinct neurostructural correlates of impulsivity in BPD and ADHD. While both disorders show impulsivity as one of their main symptoms, the fundamental brain structures associated with this trait are different. BPD is primarily associated with abnormalities in the prefrontal cortex and limbic system, whereas the alterations seen in ADHD tend to focus on the caudate nucleus and frontostriatal pathways. Further research is needed to clarify these differences and their implications for treatment.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai

Background

Child and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training.

Objective

This study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai's primary care setting. It also assessed family physicians' involvement and preparedness in this domain.

Methods

Using a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges.

Results

Findings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages.

Conclusion

Enhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai's primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

Audiovisual Integration Decreases Inhibition of Return in Children With ADHD

OBJECTIVES

Previous studies have widely demonstrated that inhibition of return (IOR) with audiovisual targets decreases due to audiovisual integration (AVI). It is currently unclear, however, whether the impaired AVI in children with ADHD has effects on IOR. The present study used the cue-target paradigm to explore differences between the IOR of audiovisual targets and the IOR of visual targets in ADHD and typically developing (TD) children.

METHOD

A total of 81 native Chinese speakers aged 6 to 13 years were recruited, including 38 children with ADHD and 43 age- and sex-matched TD children.

RESULTS

The results showed that there was a smaller magnitude of IOR with audiovisual targets as compared with visual targets in the two groups. Importantly, the reduction of IOR in audiovisual conditions was significantly smaller in children with ADHD than in children with TD. Race model analyses further confirmed that differences in IOR between ADHD and TD are due to deficits of audiovisual integration in ADHD.

CONCLUSION

The results indicated that children with ADHD have impaired audiovisual integration, which has a minimal impact on IOR.

Changes in the prevalence of intellectual disability among 10-year-old children in Sweden during 2011 through 2021: a total population study

BACKGROUND

Recent studies have suggested an increasing prevalence of intellectual disability diagnoses in some countries. Our aim was to describe the trend in the prevalence of intellectual disability diagnoses in Sweden and explore whether associated sociodemographic and perinatal factors can explain changes in the prevalence.

METHODS

We used a register-based nationwide cohort of residents in Sweden born between 2001 and 2011. We calculated the prevalence of intellectual disability diagnoses by age 10 for each birth cohort and the prevalence ratios in relation to the baseline year 2011, overall and by severity of intellectual disability, and comorbidity of autism and attention-deficit/hyperactivity disorder. The prevalence ratios were stratified and adjusted for associated sociodemographic and perinatal factors.

RESULTS

Among 1,096,800 individuals, 8,577 were diagnosed with intellectual disability by age 10. Among these, 3,949 (46%) and 2,768 (32%) were also diagnosed with autism and attention-deficit/hyperactivity disorder, respectively, and 4% were diagnosed with profound, 8% severe, 20% moderate, 52% mild, and 16% other/unspecific intellectual disability. The recorded age-10 prevalence of intellectual disability diagnoses increased from 0.64% (95% confidence interval 0.59-0.69%) in 2011 to 1.00% (0.94-1.06%) in 2021, corresponding to an annual prevalence ratio of 1.04 (1.04-1.05). The increase was, however, restricted to mild, moderate, and other/unspecific intellectual disability diagnoses, while the trends for profound and severe intellectual disability diagnoses were stable. The increasing trend was perhaps less pronounced among females and children with diagnosed attention-deficit/hyperactivity disorder, but independent of the co-occurrence of autism. The prevalence ratios did not change with stratification or adjustment for other associated demographic and perinatal factors.

CONCLUSION

The recorded prevalence of diagnosed mild and moderate intellectual disability among 10-year-olds in Sweden has increased over the recent decade. This increase could not be explained by changes in associated sociodemographic or perinatal factors, including birth weight, gestational age, and parental age, migration status, and education at the child's birth. The increase instead may be due to changes in diagnostic practices in Sweden over time.

Prevalence of attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis

BACKGROUND

The estimates of attention-deficit hyperactivity disorder (ADHD) prevalence across various studies are significantly variable, contributing to uncertainty in ADHD prevalence estimation. Previous systematic reviews and meta-analyses have attributed this variability primarily to the methodological characteristics of the studies, including the diagnostic criteria, source of information, and impairment requirement for the diagnosis.

METHODS

Review identified studies reporting ADHD prevalence in representative samples of children and adults in Europe and worldwide. Studies that were conducted in the general population were included. We focused on studies that report ADHD prevalence based on clinical diagnosis (clinical diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases criteria, other diagnostic tools, such as various scales or interviews based on clinical diagnostic criteria). PubMed/Medline was searched to identify relevant articles published until 2024/2/01. The study was registered in PROSPERO (CRD42020200220) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for systematic review and meta-analysis.

RESULTS

In total, 117 studies were subjected to full evaluation. In the meta-analysis, 103 studies representing 159 independent datapoints were included. The overall prevalence of ADHD in register studies was 1.6%, 95% CI [0.9; 3.0], in survey studies 5.0%, 95% CI [2.9; 8.6], in one-stage clinical studies 4.2%, 95% CI [2.9; 6.0], and in two-stage clinical studies 4.8%, 95% CI [4.0; 5.8].

CONCLUSIONS

Exact comparisons among studies with different diagnostic criteria and types of sampling can impact prevalence estimates. When comparing data from methodologically different studies, these factors need to be considered.

Individual child factors affecting the diagnosis of attention deficit hyperactivity disorder (ADHD) in children and adolescents: a systematic review

Attention deficit hyperactivity disorder (ADHD) is a prevalent condition characterised by patterns of inattention, hyperactivity, and impulsivity. This systematic literature review aims to identify the child clinical and sociodemographic factors related to the detection and diagnosis of ADHD in children and adolescents, given concerns about delays or failures in identifying ADHD as well as over-diagnosis, hindering appropriate and timely support for children and families. Through electronic and manual searches of peer-reviewed and grey literature, 5852 articles were identified and subjected to two stages of screening by independent reviewers. Due to the heterogeneity in study methods, a narrative approach was used to summarise study findings. Forty-one studies meeting eligibility criteria revealed sixteen child-related factors influencing the ADHD diagnostic process. These factors include ADHD subtype, ADHD symptom severity, comorbid mental disorders, behavior problems, internalizing symptoms, functional impairment, social and cognitive functioning, physical health, gender, age, relative age, race/ethnicity, socio-economic status, insurance coverage, residence urbanicity, and family structure. While the impact of many of these factors on ADHD diagnosis was inconsistent due to the substantial diversity in study designs and context, certain patterns emerged. Meeting the criteria for the inattentive subtype, lower functional impairment, female gender, Black or Latinx ethnicity, and being relatively young for their grade were consistently found to be associated with a delayed or absent ADHD diagnosis. Further research is needed to explore the intricate relationships between these child-level variables and their implications for ADHD recognition, referral, and evaluation, especially outside the USA.

Exploring causal associations of antioxidants from supplements and diet with attention deficit/hyperactivity disorder in European populations: a Mendelian randomization analysis

Background

Antioxidants from both supplements and diet have been suggested to potentially reduce oxidative stress in individuals with ADHD. However, there is a lack of studies utilizing the Mendelian randomization (MR) method to explore the relationship between dietary and supplemental antioxidants with ADHD.

Methods

This study employed two-sample mendelian randomization. Various specific antioxidant dietary supplements (such as coffee, green tea, herbal tea, standard tea, and red wine intake per week), along with diet-derived circulating antioxidants including Vitamin C (ascorbate), Vitamin E (α-tocopherol), Vitamin E (γ-tocopherol), carotene, Vitamin A (retinol), zinc, and selenium (N = 2,603-428,860), were linked to independent single nucleotide polymorphisms (SNPs). Data on ADHD was gathered from six sources, comprising 246,888 participants. The primary analytical method utilized was inverse variance weighting (IVW), with sensitivity analysis conducted to assess the robustness of the main findings.

Results

In different diagnostic periods for ADHD, we found that only green tea intake among the antioxidants was significantly associated with a reduced risk of ADHD in males (OR: 0.977, CI: 0.963-0.990, p < 0.001, FDR = 0.065), with no evidence of pleiotropy or heterogeneity observed in the results. Additionally, a nominal causal association was found between green tea intake and childhood ADHD (OR: 0.989, 95% CI: 0.979-0.998, p = 0.023, FDR = 0.843). No causal relationships were detected between the intake of other antioxidant-rich diets and ADHD.

Conclusion

Our study found a significant inverse association between green tea intake and male ADHD, suggesting that higher green tea consumption may reduce ADHD risk in males. Further research is needed to explore optimal doses and underlying mechanisms.

Post-COVID-19 Yearly Pattern Changes and Gender Variations in Attention Deficit Hyperactivity Disorder Patients at an Urban Mental Health Clinic in Alabama, USA

Introduction The COVID-19 era has seen an increased trend in attention deficit hyperactivity disorder (ADHD) diagnoses. Historically, males have been diagnosed with ADHD more frequently than females during childhood. Studies have indicated a higher use of stimulant medications among male ADHD cases compared to females. This study examines ADHD cases from 2021 to 2023 to analyze yearly trends following the initial COVID-19 spike and explores gender and age differences between ADHD-positive and ADHD-negative cases. Methods This retrospective study was conducted using data from an urban outpatient mental health clinic in Alabama. Data were extracted from Electronic Health Records (EHR) for patients seen from January 1, 2021, to December 31, 2023. The Institutional Review Board (IRB) approved the study under the exempt research category. Data were analyzed using Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY). Diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, and clinical diagnoses and medication information were obtained from the EHR. Results The study included 1,422 patients, of whom 881 (62%) were diagnosed with ADHD. Females with ADHD had significantly higher comorbid conditions, such as major depressive disorder, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder, compared to males with ADHD. Gender differences in ADHD diagnoses were seen over the years, though no significant age differences were observed. Conclusions The study indicates a sustained high rate of ADHD diagnoses even after the initial COVID-19 spike. Females showed a higher ADHD diagnoses compared to males, but stimulant medication use remained consistent across genders. No significant age differences were observed between males and females with ADHD. Further research is needed to explore the reasons behind these gender differences and to evaluate their implications.

Leveraging an intensive time series of young children's movement to capture impulsive and inattentive behaviors in a preschool setting

Studying within-person variability in children's behavior is frequently hindered by challenges collecting repeated observations. This study used wearable accelerometers to collect an intensive time series (2.7 million observations) of young children's movement at school (N = 62, Mage = 4.5 years, 54% male, 74% Non-Hispanic White) in 2021. Machine learning analyses indicated that children's typical forward acceleration was strongly correlated with lower teacher-reported inhibitory control and attention (r = -.69). Using forward movement intensity as a proxy for impulsivity, we partitioned the intensive time series and found that (1) children modulated their behavior across periods of the school day, (2) children's impulsivity increased across the school week, and (3) children with greater impulsivity showed greater variability in behavior across days.

Trends in Pediatric Attention-Deficit Hyperactive Disorder Diagnoses and Prescription Utilization: 2016 to 2019

OBJECTIVE

Attention-deficit hyperactive disorder (ADHD) is one of the most common psychiatric disorders among children, with estimated prevalence of 7% to 15% worldwide. The aim of this analysis was to update and summarize trends in diagnosis, demographics, and drug utilization of pediatric patients with ADHD.

METHODS

We used the Agency for Health care Research and Quality Medical Expenditure Panel Survey (MEPS), a survey of US individuals, families, their medical providers, and employers, using datasets from 2016 to 2019. The data sources from the MEPS database included the full-year consolidated files, medical conditions files, prescribed-medicines files, and condition-event link files for each year. We summarized trends in the proportion of children, ages 17 years and younger, with a diagnosis of ADHD, demographic information and a prescription for medication known to treat ADHD. In addition, we further stratified ADHD medication use by stimulant/nonstimulant categories.

RESULTS

There was a 1.6% and 4.7% absolute increase in children with an ADHD diagnosis and those prescribed ADHD medications, respectively, from 2016 to 2019. Most of these children were male, non-Hispanic, and on public insurance. Of the children prescribed an ADHD medication and concomitant behavioral medications, stimulants-only use was the highest (60%-67%), followed by stimulants/nonstimulants (13%-15%), stimulant/antidepressants (6%-9%), and nonstimulants only (5%-9%). The proportion of patients with ADHD in the high-income and near-poor categories increased by 4% from 2016 to 2019.

CONCLUSION

Diagnosis of ADHD among children is trending upward in the United States. Central nervous system stimulants, especially methylphenidate formulations, are the most prescribed ADHD medications for children 17 years and younger.

Neurodevelopmental disorders in children seeking obesity treatment- associations with intellectual ability and psychiatric conditions

Background

Neurodevelopmental disorders (NDD), psychiatric comorbidity and cognitive deficits are commonly seen in children with obesity; however, little is known about the overlap between these conditions. This study aimed to examine the undiagnosed and diagnosed frequency of NDDs and explore its association with psychiatric conditions and general intellectual ability (IQ) in children presenting for obesity treatment.

Methods

In this observational study at two outpatient obesity clinics during 2018-2019, 80 children (8-17 years) were consecutively recruited, and screened for NDD unless already diagnosed with an NDD. A psychiatric unit evaluated children who screened positive for NDD. Diagnoses and clinical background factors were collected from medical records. IQ was assessed with the Weschler Intelligence Scales and internalizing symptoms were assessed using the Beck Youth Inventories. Associations between background factors, IQ and internalizing symptoms were explored in relation to having an NDD or not.

Results

We found that 47/80 children had at least one NDD. Children with a diagnosed NDD before study start (n = 30) had significantly more comorbidities than children diagnosed after the study screening (n = 17) (P = .01). Greater cognitive impairment was seen in children with NDD compared with children without an NDD (P = .01). Also, 33/73 participants self-reported substantial internalizing symptoms. At follow-up, 21/79 participants, in addition to NDD, had been diagnosed with another psychiatric disorder. Ten of these were children that had been diagnosed with an NDD before study start.

Conclusion

The overlap between NDD, cognitive deficits and psychiatric conditions in children with obesity is an important consideration for clinical practice. Screening for these conditions may be necessary when providing targeted interventions.

Atopic Dermatitis and Autism Spectrum Disorders: Common Role of Environmental and Clinical Co-Factors in the Onset and Severity of Their Clinical Course

Increasing evidence suggests an association between atopic dermatitis, the most chronic inflammatory disease of the skin, and autism spectrum disorders, which are a group of neurodevelopmental diseases. Inflammation and immune dysregulation associated with genetic and environmental factors seem to characterize the pathophysiological mechanisms of both conditions. We conducted a literature review of the PubMed database aimed at identifying the clinical features and alleged risk factors that could be used in clinical practice to predict the onset of ASD and/or AD or worsen their prognosis in the context of comorbidities.

Correlational Insights into Attention-Deficit/Hyperactivity Disorder in Lebanon

Attention-Deficit/Hyperactivity Disorder (ADHD), a prevalent childhood neurodevelopmental disorder with complex etiology involving genetic and environmental factors, causes impairments across various life domains and substantial social and economic burden. Identifying correlates to prevent its onset and decrease its incidence is crucial. To our knowledge, our study represents the first case-control investigation of Lebanese ADHD patients to explore potential correlations between familial, maternal, and child health variables and ADHD to enhance understanding of its etiology and aid in prevention efforts. We recruited 61 Lebanese ADHD patients and 58 matched controls aged 6-24 years from all districts of Lebanon. The data to analyze were collected using a questionnaire. We employed statistical tests, including the independent samples t-test and the Chi-square test or Fisher's exact test. We conducted a multivariate logistic regression analysis to identify the statistically significant factors explaining ADHD likelihood. We observed male predominance (68.9%) among patients. Maternal anemia during pregnancy (OR = 3.654; 95% CI [1.158-11.529]), maternal self-reported stress during pregnancy (OR = 3.268; 95% CI [1.263-8.456]), neonatal jaundice (OR = 5.020; 95% CI [1.438-17.532]), and familial history of ADHD (OR = 12.033; 95% CI [2.950-49.072]) were significantly associated with increased odds of the disorder. On the other hand, breastfeeding (OR = 0.263; 95% CI [0.092-0.757]) was identified as a protective factor against ADHD. This pilot study shed light on risk and protective factors associated with ADHD in the Lebanese population. The results are relevant, as some identified correlates could be avoidable. Further rigorous investigation is required to expand upon the observed correlations and to assist in early detection, prevention, and intervention strategies targeting ADHD.

Psychotropic Medication Usage in Pediatric CKD: Reporting from the CKD in Children Cohort

Key Points

Psychotropic medication use is prevalent in the pediatric CKD population. Central nervous system stimulant usage was more common in male patients, and antidepressant usage was more frequently reported at follow-up visits during teenage years.

Background

Mental health disorders within the pediatric CKD population are prevalent. The frequency is unknown with which psychotropic medications that commonly treat these conditions are used in this population.

Methods

Data from the CKD in Children (CKiD) cohort study were used to describe the use of psychotropic medications and patient-related characteristics of use. Medications were classified into three groups: antidepressants, central nervous system (CNS) stimulants, and antipsychotic/mood stabilizing medications. Participant age, sex, CKD severity, and duration of medication use were ascertained. Medication use was evaluated in parallel with CKD disease type, presence of urological comorbidity, and hypertension. Chi-square tests compared subgroup medication use.

Results

Among 1074 CKiD participants (median baseline age 9.8 years), 6% (n =60) used psychotropic medications at study entry with 11% reporting incident use of any medication category (n =120). CNS stimulants were most common at baseline. Antidepressants were more frequent among incident users at 7%. Use of two or more medications was rare (3%). Median eGFR at medication initiation was 45 ml/min per 1.73 m2. CNS stimulants were reported at a higher rate in male compared with female participants (P < 0.05).

Conclusions

Eleven percent of CKiD patients report incident use of any psychotropic medication, with 7% reporting incident use of antidepressants. Future work is warranted to better ascertain the frequency, safety, and efficacy of psychotropic medication usage in relationship to formal mental health disorder diagnoses in the pediatric CKD population.

Two single arm trials of AKL-T01, a digital therapeutic for adolescents and adults with ADHD

Inattention symptoms represent a key driver of functional impairment in ADHD and often persist into adolescence and adulthood, underscoring a need for novel treatments targeting attentional control. We evaluated AKL-T01-a digital therapeutic that is FDA-cleared for children 8-12 y with ADHD-in adolescents and adults with ADHD in two independent single-arm trials: STARS-ADHD-Adolescent, a 4-week trial in adolescents 13-17 y (n = 162 enrolled), and STARS-ADHD-Adult, a 6-week trial in adults 18 and older (n = 221 enrolled). AKL-T01 was linked with improvements on the Test of Variables of Attention (TOVA®) Attention Comparison Score (ACS) of 2.6 (95% CI: 2.02, 3.26; p < 0.0001) in adolescents and 6.5 in adults (95% CI: 5.35, 7.57; p < 0.0001), along with improvements in secondary endpoints. 15 participants reported adverse device effects, all mild or moderate. Though limited by a single-arm design, results provide preliminary support for the safety and efficacy of AKL-T01 for adolescents and adults with ADHD.

The experience of effort in ADHD: a scoping review

Background

Mental effort plays a critical role in regulating cognition. However, the experience of mental effort may differ for individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), a disorder for which sustained mental effort 'avoidance' or 'dislike' is a criterion in the DSM. We conducted a scoping review to characterize the literature on the experiences of effort in ADHD.

Methods

This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology. PsycINFO (OVID), PsycINFO (ProQuest) and PubMed were searched for studies published in English before February 14, 2023. Studies must have included an ADHD population or a measure of ADHD symptomatology, in addition to a self-report measure of the experience of effort or the use of an effort preference paradigm. Two researchers reviewed all abstracts, and one researcher reviewed full-text articles.

Results

Only 12 studies met the inclusion criteria. Several gaps and inconsistencies in the research were identified in terms of method, definitions of effort, measurements of ADHD, and sample characteristics. Moreover, the pattern of results on the experience of effort was mixed.

Conclusion

Despite its diagnostic and conceptual significance, the experience of mental effort in ADHD is not well studied. Critical gaps were identified in the existing literature. A three-facet conceptualization of effort is proposed-specifically, task-elicited effort, volitionally exerted effort, and the affect associated with engaging in effort - to guide future explorations of the experience of effort in ADHD.

A Post-Hoc Analysis of Emotional Lability With Delayed-Release/Extended-Release Methylphenidate in Children Aged 6 to 12 Years of Age Participating in Two Phase 3 Clinical Trials

OBJECTIVE

DR/ER-MPH (formerly HLD200) is an evening-dosed delayed-release and extended-release methylphenidate approved for the treatment of ADHD in patients ≥6 years. Post hoc analyses of two pivotal Phase 3 trials: HLD200-107 (NCT02493777) and HLD200-108 (NCT02520388) evaluated emotional lability (EL) with DR/ER-MPH treatment.

METHODS

Differences in Conners Global Index-Parent (CGI-P) EL subscale scores and age- and gender-adjusted T-scores over an open-label titration phase (HLD200-107) and between treatment and placebo groups at endpoint (HLD200-108) were evaluated.

RESULTS

In HLD200-107 (N = 117) mean CGI-P EL subscale scores improved from 5.3 to 1.3 (p < .0001) after 6 weeks; in HLD200-108 significant improvements were observed in the treatment group (n = 81) versus placebo (n = 80; 3.11 vs. 4.08; p = .0053). T-scores showed an improvement with DR/ER-MPH treatment in both trials. Few emotional adverse events (AEs) were reported.

CONCLUSION

DR/ER-MPH treatment resulted in statistically significant improvements in EL to the level of non-ADHD peers as contextualized by T-scores.

The Association Between ADHD in Adolescence and Injury in Early Adulthood in Israel: A Nationwide Historical Cohort Study

OBJECTIVE

To examine the association between late adolescence ADHD and the risk of serious injury in early adulthood.

METHOD

A nationwide cohort study utilizing data from the Military Health Examinations Database for potential military recruits (age 16.5-18 years), cross-referenced with the Israeli National Trauma Registry (2008-2020). Individuals with and without ADHD (mild/severe) were compared for early adulthood injury risk using Cox models.

RESULTS

This study compared 76,403 participants with mild ADHD (18.76%) and 330,792 without (81.24%), alongside 2,835 severe ADHD participants (1.11%) versus 252,626 without (98.89%). Adjusted hazard ratios for injury-related hospitalization were 1.27 (95% CI [1.17, 1.37]) for mild ADHD and 1.40 (95% CI [1.09, 1.79]) for severe ADHD, compared to non-ADHD.

CONCLUSIONS

Adolescents with ADHD, regardless of severity, had a significantly higher risk of hospitalization due to injury that persists into early adulthood, underscoring the importance of recognizing ADHD as an injury risk and incorporating it into injury prevention strategies.

Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings

The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.

ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment

OBJECTIVE

To provide updated national prevalence estimates of diagnosed attention-deficit/hyperactivity disorder (ADHD), ADHD severity, co-occurring disorders, and receipt of ADHD medication and behavioral treatment among U.S. children and adolescents by demographic and clinical subgroups using data from the 2022 National Survey of Children's Health (NSCH).

METHOD

This study used 2022 NSCH data to estimate the prevalence of ever diagnosed and current ADHD among U.S. children aged 3-17 years. Among children with current ADHD, ADHD severity, presence of current co-occurring disorders, and receipt of medication and behavioral treatment were estimated. Weighted estimates were calculated overall and for demographic and clinical subgroups (n = 45,169).

RESULTS

Approximately 1 in 9 U.S. children have ever received an ADHD diagnosis (11.4%, 7.1 million children) and 10.5% (6.5 million) had current ADHD. Among children with current ADHD, 58.1% had moderate or severe ADHD, 77.9% had at least one co-occurring disorder, approximately half of children with current ADHD (53.6%) received ADHD medication, and 44.4% had received behavioral treatment for ADHD in the past year; nearly one third (30.1%) did not receive any ADHD-specific treatment.

CONCLUSIONS

Pediatric ADHD remains an ongoing and expanding public health concern, as approximately 1 million more children had ever received an ADHD diagnosis in 2022 than in 2016. Estimates from the 2022 NSCH provide information on pediatric ADHD during the last full year of the COVID-19 pandemic and can be used by policymakers, government agencies, health care systems, public health practitioners, and other partners to plan for needs of children with ADHD.

Changes in the severity of autism symptom domains are related to mental health challenges during middle childhood

LAY ABSTRACT

For many autistic children, the severity of their autism symptoms changes during middle childhood. We studied whether these changes are associated with the emergence of other mental health challenges such as anxiety and attention-deficit hyperactivity disorder. Children who had increased social-communication challenges had more anxiety and attention-deficit hyperactivity disorder symptoms and disruptive behavior problems than other children. Children who decreased their restricted and repetitive behaviors, on the contrary, had more anxiety. We discuss why these changes in autism symptoms may lead to increases in other mental health concerns.

Can an active lifestyle reduce the risk of obesity in adulthood among adolescents with Attention-Deficit/Hyperactivity Disorder symptoms? An ambispective cohort study

Various studies have associated Attention-Deficit/Hyperactivity Disorder (ADHD) with obesity, but the role of physical activity in this connection is uncertain. This study examined whether adopting an active lifestyle can mitigate the link between adolescent ADHD and the risk of adult obesity. Longitudinal data from the Add Health Study (Waves I, III, and V) were used. Participants self-reported ADHD symptoms (hyperactivity/impulsivity, inattention, combined) during Wave III and self-assessed their recent moderate-to-vigorous physical activity. An "active lifestyle" required meeting activity criteria in both adolescence (Wave I) and adulthood (Wave III-V). Of 2609 participants, 1.42 % exhibited combined ADHD symptoms. A non-linear relationship was observed between inattentive/hyperactive scores and body mass index (BMI) and waist circumference (WC). Individuals with ≥ 6 hyperactivity/impulsivity symptoms had higher BMI (1.29 kg/m²) and WC (1.27 cm) at adulthood. Logistic regressions indicate that, compared to individuals without ADHD maintaining an active lifestyle, both inactive participants with and without ADHD show an elevated risk of obesity (odds ratio [OR]=1.56 to 2.63) and abdominal obesity in adulthood (OR = 1.51 to 2.50). Mediation analysis models further confirm these findings, suggesting that physical activity may explain this association. Though exact mechanisms warrant further exploration, adopting an active lifestyle offers promise for reducing obesity risk among individuals with ADHD symptoms.

Stimulant Patterns, Alone or with Other Psychotropic Classes, in Medicaid-Insured Youth Continuously Enrolled for 3-8 Years

Objective: Little U.S. pharmacoepidemiologic study is based on treatment during continuous enrollment for periods more than a year. This study aims to show pediatric patterns of stimulant use (alone or with other psychotropic classes) from Medicaid administrative claims data for stimulant patterns of 3- to 8-year continuous enrollees. Methods: A retrospective cohort study was derived from Medicaid enrollment, pharmacy, and diagnosis claims data (2007-2014) in a mid-Atlantic state. Youth aged 2-17 years with 3-8 years of continuous enrollment treated with stimulants were compared with a date-matched comparison group treated without stimulants. Major outcomes include prevalence and duration of stimulant use and patterns of stimulant polypharmacy across relatively long enrollments (3-8 years). Results: Among 264,518 unique 2- to 17-year olds with 3-8 years of continuous enrollment, 16.5% had stimulant prescription dispensings, doubling the annual national prevalence of 8.1%. Subgroup analysis showed that the highest prevalence of stimulant use was for 6- to 11-year olds (20.4%), foster care eligible youth (42.3%), and those with 7-8 years of continuous enrollment (20.1%). Externalizing psychiatric disorders were far more common in those treated with stimulants than in those treated without stimulants. The duration of stimulant exposure overall was a median of 487 days, half that of foster care stimulant users. Stimulant polypharmacy with two or more psychotropic classes concomitantly characterized 29.8% of stimulant users. Among those with three or four or more class polypharmacy, 85% and 88%, respectively, had concomitant stimulant and antipsychotic use. The adjusted odds ratio (AOR) of three or more class polypharmacy significantly increased in 12- to 17-year-old age group (AOR = 1.8), foster care eligibility (AOR = 4.5), and among those with the longest enrollment (AOR = 1.7). Conclusions and Relevance: Stimulant prevalence in Medicaid-insured youth with continuous enrollment of 3-8 years was twice as common as in annual data sets. Future research should investigate three to five interclass stimulant polypharmacy effectiveness in reliably diagnosed community populations.

Sex Differences in ADHD: Review and Priorities for Future Research

PURPOSE OF REVIEW

In childhood, attention-deficit/hyperactivity disorder (ADHD) is diagnosed three to 16 times more frequently in males compared to females, yet in adulthood, nearly equivalent numbers of males and females are diagnosed with ADHD. Relatively few studies have prioritized examination of sex differences in ADHD even though sex differences may have critical implications for the identification and treatment of ADHD in females and males. This review highlights current research on sex differences in ADHD across the lifespan that has emerged from cross-sectional and prospective longitudinal studies of youth, adult-ascertained samples, and registry studies.

RECENT FINDINGS

Accumulating research suggests that both males and females with ADHD experience widespread impairment across the lifespan. Some evidence of sex differences emerged, although effects have generally been modest in size. Continued research that includes females and males with ADHD is needed to clarify the nature of sex differences in ADHD. Research that focuses on equitable identification of ADHD in males and females, disentangles the effects of sex and gender, probes underlying mechanisms of sex differences, and addresses the clinical impact of sex differences in ADHD must be prioritized.

Using Hot and Cool Measures to Phenotype and Predict Functional Outcomes Across Dimensions of ADHD and Typical Development in Adolescents

Multiple pathway models propose that attention deficit hyperactivity disorder (ADHD) arises from dysfunction in separate systems comprised of a "cool" or cognitive pathway versus a "hot" or emotional/reward pathway. Interactions between these pathways and the degree of maturation may further determine functional outcomes for adolescents ranging from those diagnosed with ADHD to typical development (TD). We used a latent profile analysis on rating scales and behavioral task performance assessing emotion, irritability, impulsivity, risk-taking, future orientation, and processing speed (PS) to identify subgroups of TD adolescents and adolescents with ADHD (N = 152) based on the hot and cool pathway model. We identified four classes: 1) High-Complex Challenges; 2) Moderate-Mixed Challenges; 3) Non-Emotive Impulsivity; and 4) High Regulation and Control. A multiple pathway model of ADHD is supported with classes differing in degree of emotional lability and irritability, types of impulsivity, and ability to use future consequences to modulate impulsivity and PS. The classes differed regarding functional behavior, with the High-Complex class demonstrating the most severe functional challenges in academic-related functioning. The Moderate-Mixed class also displayed significant functional challenges but with moderate emotional lability and irritability ratings. The Non-Emotive Impulsivity class exhibited low emotionality and low irritability, yet high impulsivity with limited negative functional consequences, and was composed of a mix of ADHD and TD adolescents. Differences between classes suggest ADHD symptomatology may represent both categorical and dimensional differences. Precision health interventions may be more effective in addressing the specific challenges associated with the classes rather than a one-size-fits-all approach to treating ADHD.

Changes in real-world dispensing of ADHD stimulants in youth from 2019 to 2021 in California

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric neurobehavioral disorders in the U.S. Stimulants, classified as controlled substances, are commonly used for ADHD management. We conducted an analysis of real-world stimulants dispensing data to evaluate the pandemic's impact on young patients (≤ 26 years) in California.

Methods

Annual prevalence of patients on stimulants per capita across various California counties from 2019 and 2021 were analyzed and further compared across different years, sexes, and age groups. New patients initiating simulants therapy were also examined. A case study was conducted to determine the impact of socioeconomic status on patient prevalence within different quintiles in Los Angeles County using patient zip codes. Logistic regression analysis using R Project was employed to determine demographic factors associated with concurrent use of stimulants with other controlled substances.

Results

There was a notable reduction in prevalence of patients ≤26 years old on stimulants during and after the pandemic per 100,000 people (777 in 2019; 743 in 2020; 751 in 2021). These decreases were more evident among the elementary and adolescent age groups. The most prevalent age group on stimulants were adolescents (12-17 years) irrespective of the pandemic. A significant rise in the number of female patients using stimulants was observed, increasing from 107,957 (35.2%) in 2019 to 121,241 (41.1%) in 2021. New patients initiating stimulants rose from 102,754 in 2020 to 106,660 in 2021, with 33.2% being young adults. In Los Angeles County, there was an increasing trend in patient prevalence from Q1 to Q5 income quintiles among patients ≥6 years. Consistently each year, the highest average income quintile exhibited the highest per capita prevalence. Age was associated with higher risk of concurrent use of benzodiazepines (OR, 1.198 [95% CI, 1.195-1.201], p < 0.0001) and opioids (OR, 1.132 [95% CI, 1.130-1.134], p < 0.0001) with stimulants.

Discussion

Our study provides real-world information on dispensing of ADHD stimulants in California youth from 2019 to 2021. The results underscore the importance of optimizing evidence-based ADHD management in pediatric patients and young adults to mitigate disparities in the use of stimulants.

Understanding the course of attention deficit hyperactivity disorder in children born after a threatened preterm labor: a 6-year cohort study

BACKGROUND

Recent research suggests that children born after suspected preterm labor may observe a potential cluster with different attention deficit hyperactivity disorder features, depending on the time of birth. However, the evolution of symptoms and their predictors remain unknown in this population.

OBJECTIVE

This study aimed to examine the trajectories of attention deficit hyperactivity disorder symptoms of children born after suspected preterm labor, between ages 2 and 6 years, considering prematurity condition and comparing with controls. In addition, this study aimed to find potential modifiable predictors of evolution to enhance prognosis.

STUDY DESIGN

In this prospective cohort study, 119 mother-child pairs who experienced suspected preterm labor and 60 controls were included. Patients were divided according to prematurity condition in full term (n=27), late preterm (n=55), and very preterm (n=37). Attention deficit hyperactivity disorder symptoms were assessed at ages 2 and 6 years. The association between potential modifying factors (group, time of assessment, sex, birthweight percentile, maternal history of trauma, maternal anxiety at diagnosis, and maternal anxiety during the children's assessments) and disorder trajectories was assessed by adjusting the Bayesian mixed linear models. All analyses were performed in R (version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

An interaction emerged between time and group, with late-preterm neonates born after suspected preterm labor being the only group to improve from ages 2 to 6 years (-2.26 points in Conners scale per percentile decrease and 0.98 probability of effect). Another interaction between time and maternal anxiety at postnatal time assessments intensified over time (0.07 and 0.84). Predictors of symptom severity included lower weight percentile at birth (-0.2 and 0.96), male sex (-2.99 and <0.99), higher maternal anxiety at diagnosis (+0.08 and 0.99), and maternal history of trauma (+0.23 and 0.98).

CONCLUSION

Unlike very-preterm and full-term children, those born late preterm showed an improvement over time, probably because late-preterm children do not carry the sequelae derived from severe prematurity but benefit from close monitoring. As maternal psychopathology emerged as a determinant modifier of course and severity, it is crucial to develop targeted psychological interventions for pregnant individuals and reevaluate monitoring programs for their offspring, regardless of prematurity.

Rising Trends of Childhood Attention-Deficit/Hyperactivity Disorder in a Large Integrated Healthcare Delivery System in Southern California, 2010-2021

OBJECTIVE

To evaluate trends of attention-deficit/hyperactivity disorder (ADHD) diagnosis rates among children aged 5-17 years over the past decade (2010-2021) and to investigate whether there have been differences in temporal changes based on race and ethnicity, sex, or income.

STUDY DESIGN

Childhood ADHD diagnosis was ascertained from electronic health records using International Classification of Diseases ninth revision (314.xx) and International Classification of Diseases tenth revision (F90.x) codes. Data were stratified by child's sex, race and ethnicity, and household income, and rates of ADHD were estimated before and after adjustment for potential confounders.

RESULTS

The overall ADHD diagnosis rates increased from 3.5% in 2010 to 4.0% in 2021. ADHD diagnosis was most prevalent among White children (6.1%), then Black (4.6%), Other/multiple (3.7%), Hispanic (3.1%), and Asian/Pacific Islander (PI) (1.7%). ADHD was also highly prevalent among boys (73.3%) or family income≥$70,000 (50.0%). ADHD diagnosis increased among Black (4.2% to 5.1%), Hispanic (2.8% to 3.6%), and Asian/PI children (1.5% to 2.0%) but remained stable for White (6.2% to 6.1%) and Other/multiple race/ethnic children (3.7% to 3.7%). Increases in the prevalence among girls were also observed.

CONCLUSION

The prevalence of ADHD in children has risen with the largest increases observed for Black, Hispanic, and Asian/PI children. Rates among less affluent families and girls have also been increasing, narrowing the gaps in diagnosis rates previously observed. These increases may reflect improvements in screening and provision of care among demographics where ADHD has been historically underdiagnosed.